27 October 2009

Nipple Thrush

Well, here goes... my entry to the blogging world with a post on the small wisdom I gained through having nipple thrush. I will be happy if this helps just one other woman as it was a painful experience.

Important: This my story and not a substitute for professional advice. Professionals who may be of assistance include lactation consultant, naturopath, pharmacist and GP.

Diagnosis of nipple thrush is difficult. Before you look for solutions to thrush as a source of nipple pain, it is a good idea to get professional help from a lactation consultant. She will be able to check and assist with breastfeeding generally as well as helping work out if you actually have nipple thrush (rather than attachment or other problems). That being said, be aware that there are people, including health professionals, who have not heard of nipple thrush or who won’t believe that you have it.

Websites you should read

The approach
Nipple thrush can be excruciating; it caused me to wail through many feeds. Although it is not so painful for some, others, like me, find even having a shower painful. This can become a threat to ongoing breastfeeding (and therefore the baby’s health) so must be attended to with urgency and diligence. In my (limited) experience, successful resolution involves understanding the problem and attacking it from many angles at once.

It is possible and likely that the fungal infection is present in more places than just your nipples. It is a good idea to treat all possible infections at once or you risk re-infection after treatment.

Prevention is better than cure
This is probably too late to help if you are reading this for treatment ideas but if it is possible to avoid taking antibiotics during birth or while breastfeeding, that will help avoid thrush in the first place. This is one factor to consider when deciding whether or not to be tested for Streptococcus B infection in late pregnancy.

Immune system
My primary approach was to strengthen my body so that it could fight the infection itself and regain balance. I saw a naturopath for assistance in this and started taking a range of vitamins and minerals specific to my needs as well as breastfeeding-safe herbal remedies. This included immune boosters and pau d’arco which is an anti-fungal bark extract. I got as much sleep as possible and accepted any offers of help to reduce my load including having family and friends cook for us. Getting enough sunshine is also really important in winter to ensure you have enough Vitamin D and this helps with mental health also.

Candida (the fungus that causes thrush) is naturally present in the body and thrush occurs when it flourishes beyond normal levels. Restoring balance in the body’s gut flora (microorganisms in the digestive tract) is crucial to recovery. To help this process along it is highly beneficial to take ‘SB flor + inulin’ which is what the ‘good’ flora in your gut like to eat. You can take probiotics also but apparently it is much more effective to ‘feed’ the good gut flora rather than just putting more of them in. If you want to take probiotics, forget yoghurt etc and buy the capsules available from chemists and health food stores.


Candida thrives on sugar so it is helpful to reduce the amount of sugar available to it in your body. An anti-Candida diet involves avoiding foods containing sugar (including fruit), grains, dairy and yeast products. Get advice from a naturopath for more specific information and assistance, particularly if you are not familiar with dietary restrictions. This can be a hard diet to manage if you are not used to it so do some meal planning and go easy on yourself. You only need to follow it for a month or two or three so don’t worry if your meals get repetitive for a bit. I don’t normally eat much meat but found I needed to eat more in order to stick to the diet.

Breakfast ideas: Eggs OR quinoa puffs (or cooked quinoa flakes), shredded coconut, pepitas, sunflower seeds, whole bean soy milk, flaxseed oil.

Lunch ideas: this is the tough one, either eat dinner leftovers or cut a few corners (I ate a few corn thins). I ate quinoa-based bread (available from Deeks Bakery if you live in Canberra), hommous, boiled eggs, ham and lettuce.

Dinner ideas:
• Red/green curry or laksa with mung bean noodles, coconut milk and fish sauce and any of the following: organic chicken, greens, mushrooms, carrot, capsicum. Top with coriander, deep fried shallots and lime juice.
• Kangaroo with vegies (except potato and onion) or salad with good oils (eg walnut) and sesame seeds
• Dhal or Indian curry with quinoa
• Fish and vegies
• Egg meal such as omelette
• Soup such as: pumpkin, chicken, vegies, ham and pea. Add lentils or quinoa to bulk it out.
• Amaranth ‘risotto’ or substitute amaranth for quinoa in any of the above for some variety.

There is no point getting rid of the thrush only to be re-infected so I took a number of actions to prevent this from happening. I made sure the laundry was done on a hot wash or ironed the following clothes: my tops, singlets and undies; face washers; nappies, and; anything else that might touch my nipples or my baby’s bottom. You may also want to use the commercially available solutions in your washing machine and make sure you hang clothes outside to get UV from the sun.

Treatments – nipples
Topical application of some kind of anti-fungal seems important, you just have to be cautious to ensure nothing inappropriate is put there and then consumed by your baby. I used the oral solution (nystatin) that I was using in my baby’s mouth to start with (bit messy and sticky as it was never intended for topical application!) and later used gentian violet. Gentian violet is not as messy as they say and seemed to work well. It is not much fun having a baby with a purple mouth but you only use it for a week. See the gentian violet use guidelines.

Treatments – baby mouth
The baby’s mouth can be infected so it is important to treat it at the same time as treating your breasts. There are a number of options, talk to a knowledgeable pharmacist.

Treatments – baby bottom
As with the baby’s mouth, their bottom can be infected and there are a number of options for treatment from the pharmacy. I stumbled on pau d’arco lotion at my local health food store which worked well and I have found it effective ever since on the rare occasions my baby gets nappy rash.

Treatments – vagina

As with the baby’s mouth and bottom, you are quite likely to have vaginal thrush and there are a number of antifungal options for treatment (oral and topical) from the pharmacy. Take care also that your sexual partner does not also get infected and/or re-infect you.

Note that if you take antifungals, make sure the pharmacist understands that it is for nipple thrush and what that entails. I was given a single dose of fluconazole which is designed for vaginal thrush. I think helped but probably would have been better if I had taken several tablets over a period of days as indicated in the Royal Women’s Hospital guidelines.